Laparoscopic and open approaches are commonly used for appendectomy. No previous studies have specifically examined which factors determine whether a laparoscopic or open approach is used for appendectomy. We conducted a retrospective chart review of 140 patients who underwent a laparoscopic (n = 60) or open (n = 80) appendectomy between January 2000 and April 2001 at our hospital. Medical records were reviewed, and the data were analyzed using chi-square analysis, the Wilcoxon rank-sum test, and multivariate logistic regression. We studied patient age, gender, type of surgeon on call, leukocyte count, pathology, and the use of diagnostic imaging to determine whether there was any association with the use of a laparoscopic approach. The type of surgeon on call was strongly correlated with a laparoscopic approach. Of the 61 appendectomies performed by laparoscopic surgeons (those who use laparoscopy for operations other than appendectomies and cholecystectomies), 55 (90%) were laparoscopic and 6 (10%) were open. Of the 79 appendectomies performed by nonlaparoscopic surgeons, 5 (6%) were laparoscopic and 74 (94%) were open (multivariate odds ratio, 136; 95% confidence interval, 39-475; p < 0.001). The surgeon on call when a patient is admitted is an important factor determining whether a patient will receive a laparoscopic or open appendectomy.